Determinants of first prescription of hormone replacement therapy. A follow-up study among 1689 women aged 45-60 years

The aim of the present study was to ascertain the cumulative incidence of first hormone replacement therapy (HRT) and the factors that predict its prescription. In a general population 1689 women were followed for 9 months in order to trace first HRT prescriptions. Determinants (well-being, attitude towards menopause, menopausal status and another 9 variables) were measured by means of a questionnaire. Data analyses were performed for all women and for women with or without typical climacteric complaints. The cumulative 9 month incidence of HRT was 6.2%. For women without typical complaints a lower level of well-being (odds ratio 5.5; 95% Cl 1.9–15.5) and the former use of the contraceptive pill (odds ratio 4.6; 95% CI 1.0–20.5) were independently associated with HRT prescription. For women with typical complaints a positive attitude towards ‘menopause should be treated' (odds ratio 3.8; 95% Cl 1.8–8.0) was a determinant of HRT prescription. The cumulative incidence of HRT prescription is high, but from additional data it is apparent that within a period of 1 year and 9 months the majority of women stop taking HRT. For women without typical complaints, physicians prescribe HRT five times more often to those with a lower level of well-being. For women with typical complaints the physician's prescription is primarily related to the woman's attitude towards (medical) treatment of the menopause

Vasomotor symptoms and well-being in the climacteric years

Objectives: To determine more closely the relationship between vasomotor symptoms, well-being and climacteric status according to the last menstrual bleeding and according to the women themselves. Methods: A population-based cross-sectional study was executed using a postal questionnaire. Well-being of women with and without vasomotor symptoms was compared, for the different menopausal statuses. All 2729 women living in a commuter suburb of Rotterdam aged 45-60 years were approached of whom 1947 (71.3%) responded. Well-being was measured by the Inventory of Subjective Health (ISH) and three subscales of the Sickness Impact Profile (SIP). Results: The results showed that the relationship between vasomotor symptoms and well-being was dependent on climacteric status. Pre- and (middle and late) postmenopausal women with vasomotor symptoms more often experienced a relatively lower level of well- being compared to women without these symptoms. However, when the prevalence of vasomotor symptoms is as its peak, i.e. in late perimenopause, a difference in the level of well-being between women with and without vasomotor symptoms was absent. Conclusions: It is concluded that well-being and vasomotor symptoms were inversely related in all menopausal statuses except for the (late) perimenopausal phase. For this no somatic explanation seems plausible. A more social scientific explanation is suggested

Duration of hormonal replacement therapy in general practice; a follow- up study

Objectives: To assess the mean duration of use of HRT in general practice and to identify determinants of the duration of HRT use. Methods: A general population of 1689 women aged 45-60 years and enlisted in five group practices of general practitioners were followed for 9 months to trace first HRT prescriptions. All 103 women who were prescribed HRT were followed for a period of 2.25 years. Duration of HRT was assessed by using the data provided on the dispensing of HRT. Possible determinants of duration of use, such as attitude towards menopause, menopausal status and another six variables were measured by means of a questionnaire. Results: None of the 103 women received HRT for a preventive purpose; the main indication was menopausal complaints. More than 60% of the women stopped their HRT within 6 months and only 8% of the women remained on HRT for more than 2 years. The mean duration of use was 7 months. Determinants that significantly predicted the duration of HRT use were age, attitude towards treatment of the menopause and the group practice. Conclusions: The mean duration of HRT use is very short, despite the fact that the most prevalent indication is the alleviation of menopausal symptoms. Apparently, Dutch women are presently unwilling to take HRT for longer periods

Hierarchical simulations of hybrid polymer-solid materials

Complex polymer-solid materials have gained a lot of attention during the last 2-3 decades due to the fundamental physical problems and the broad spectrum of technological applications in which they are involved. Therefore, significant progress concerning the simulations of such hybrid soft-hard nanostructured systems has been made in the last few years. Simulation techniques vary from quantum to microscopic (atomistic) up to mesoscopic (coarse-grained) level. Here we give a short overview of simulation approaches on model polymer-solid interfacial systems for all different levels of description. In addition, we also present a brief outlook concerning the open questions in this field, from the point of view of both physical problems and computational methodologies

Molecular dynamics studies of model Langmuir and Langmuir-Blodgett films

Molecular dynamics computer simulation techniques have been applied to study model amphiphilic molecules adsorbed on solid and water surfaces. Initial studies, in which the amphiphiles were represented by a united atom model of a 20 carbon n-alkane and the area per chain varied from 20.8 A\sp2 to 35.2 A\sp2, showed that the chains are tilted relative to the surface normal. The tilt angle and number of gauche defects increase with area per chain, but the bulk density of methylene groups remains constant. United atom and all atom models for the hydrocarbon chains were compared for systems with areas between 18.4 and 22.0 A\sp2/chain. Chain tilt varies with area per chain in the same manner as experiment for both models, with the molecular dynamics results shifted to lower area. The chains were in a rotator phase at 300 K for all densities studied. The all atom model of the chains is superior for high density systems. Finally, a simulation of a C\sb{20}H\sb{41}COOH Langmuir monolayer was carried out in which amphiphiles and water molecules were modeled in full atomic detail and the dynamics of both species was followed for more than 500 ps. The system was very stable, demonstrating the feasibility of carrying out realistic simulations of large, complex systems